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Oral midazolam preanesthetic medication in pediatric outpatients
L H Feld1, J B Negus, P F White
1Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110.
Insights
Oral midazolam combined with atropine effectively sedates pediatric patients before surgery. Doses of 0.5-0.75 mg/kg provided safe and effective preanesthetic medication for children undergoing outpatient procedures.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Care
Background:
- Establishing safe and effective oral preanesthetic medications for pediatric patients is crucial for elective surgeries.
- Current preanesthetic options require further evaluation for efficacy and safety in young surgical candidates.
Purpose of the Study:
- To assess the effectiveness of three different oral midazolam doses combined with atropine as a preanesthetic medication in children.
- To evaluate sedation levels, separation anxiety, cooperation, and amnesic effects in pediatric outpatients.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 124 children aged 1-10 years.
- Administration of oral midazolam (0.25, 0.50, or 0.75 mg/kg) with atropine (0.03 mg/kg) or placebo.
- Assessment of sedation, separation, cooperation, and amnesia using blinded observation and picture-recall tests.
Main Results:
- Oral midazolam at 0.75 mg/kg demonstrated significant sedation within 30 minutes.
- The midazolam-atropine combination did not prolong recovery times after procedures averaging 106-113 minutes.
- No adverse effects on recovery were noted with the oral preanesthetic regimen.
Conclusions:
- Oral midazolam, particularly at doses of 0.5-0.75 mg/kg when combined with atropine, is an effective preanesthetic option for pediatric outpatients.
- This regimen offers a safe and viable alternative for preparing children for ambulatory surgery.
- Further research may explore optimal dosing and patient selection for oral midazolam preanesthesia.
Abstract:
A need exists for a safe and effective oral preanesthetic medication for use in children undergoing elective surgical procedures. We evaluated the effectiveness of three different doses of oral midazolam when administered in combination with atropine prior to ambulatory surgery. In this randomized, double-blind, placebo-controlled study, 124 children, ages 1-10 yr, received midazolam, 0.25, 0.50, or 0.75 mg.kg-1 po, and atropine, 0.03 mg.kg-1 po, mixed with apple juice, or a placebo (containing the midazolam vehicle, atropine, and apple juice). A blinded observer noted the child's level of sedation, the quality of separation from parents, and the degree of cooperation with an inhalation induction of anesthesia. Picture-recall was used to assess the amnesic effect of midazolam in children over 5 yr of age. Midazolam 0.75 mg.kg-1 produced significant sedation at 30 min. After procedures lasting an average of 106-113 min, recovery was not prolonged by the oral midazolam-atropine combination. We concluded that oral midazolam 0.5-0.75 mg.kg-1 is an effective preanesthetic medication for pediatric outpatients.